Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore
Annexure II
1.
Name of the candidate and
address (in block letters)
ABHINAV VERMA
Dr. M. V. SHETTY COLLEGE OF PHYSIOTHERAPY,
VIDYA NAGAR, KULOOR,
MANGALORE-575013
2.
Name of the Institution
Dr. M. V. SHETTY COLLEGE OF PHYSIOTHERAPY
3.
Course of study and subject
MASTER OF PHYSIOTHERAPY (MPT)
(CARDIORESPIRATORY DISORDERS)
4.
Date of admission
31st May, 2010.
5.
Title of the Topic
A STUDY TO EVALUATE PULMONARY FUNCTION
TEST VALUES AMONG THREE WHEELER
DRIVERS AND USEFULNESS OF PROTECTIVE
MASK IN REDUCING RESPIRATORY SYMPTOMS.
6.
Brief Resume of the Intended Work
6.1) INTRODUCTION AND NEED OF THE STUDY:
Air pollution has been aggravated by developments that typically occur as countries become
industrialized: growing cities, increasing traffic, rapid economic development and industrialization,
and higher levels of energy consumption. The high influx of population to urban areas, increase in
consumption patterns and unplanned urban and industrial development have led to the problem of
Air pollution Currently, in India, air pollution is widespread in urban areas where vehicles are the
major contributors and in a few other areas with a high concentration of industries and thermal
power plants. Vehicular emissions are of particular concern since these are ground level sources and
thus have the maximum impact on the general population. Also, vehicles contribute significantly to
the total air pollution load in many urban areas 1.
Any kind of imbalance in the biosphere results in environmental pollution. Rapid industrialisation,
urbanisation, use to motor vehicles, agriculture, nuclear energy program are the major causes of
environmental pollution in the world. Experimental studies indicate that due to airborne
contaminants of diesel fumes, changes in PFTs are seen due to injury to airways and parenchyma in
subjects who are exposed to it, because lungs are the major site of contact between the body and the
environment 2.
The human lungs encounter approximately 7 liters of air per minute. Thus it is evident that lungs are
a target for adverse effects of noxious gases due to air pollution. The airborne contaminants include:
Nitric oxide (NO2), Carbon mono oxide (CO), Carbon dioxide (CO2), Ozone (O3) Sulphur dioxide
(SO2), Hydrocarbons and Suspended particulate matters (SPM). They are responsible for injury to
airways and lung parenchyma and lead to bronchoconstriction, increased mucous secretion and
increased alveolar swelling. Nitrous fumes may results acute pulmonary oedema 2.
Incidence and prevalence of vehicular pollution showed that motor vehicles such as automobile,
trucks, and buses are the primary sources of air pollution nearly everywhere in India. India alone
was having 37.6 million vehicles in 1997 of which over a million are 3 wheelers. Numerous studies
have found association between occupational exposure to diesel exhaust and lung cancer. Truly
exposed group to urban pollution and automobile exhaust showed a grater prevalence of symptoms
(Cough, Wheeze and Dyspnoea) 3.
Relationship between vehicular pollution and pulmonary function test values shows that high level
of SO2 exposure causes chronic bronchitis, in which the values of FEV1 were reduced 2-4, workers
in garage was mostly of obstructive type and there was deterioration of FVC and FEV1 2, Inhalation
of NO2 and SO2 causes obstructive and restrictive disorders of lungs 2, Particulate matter pose the
most serious threat to human health by penetrating deep into lung in addition to direct emissions of
fine particles automobiles release nitrogen oxides, hydrocarbons, and sulfur dioxide, which generate
additional fine particles as secondary pollution 5.
Need of the Study:
Previously studies and survey has shown the effect of air pollution on the respiratory system and
pulmonary values of humans. Studies have also shown that three wheeler drivers are most affected
by the air pollutants like NO2, PM, SO2 2. As these are the major pollutants of pollution caused by
vehicle and these drivers are the one who spend most of their time in traffic.
So there is insufficient data related to the intervention used to prevent and improve the respiratory
problems and PFT values among three wheeler drivers.
Research Question:
Will the pulmonary function test values be influenced by using mask as an intervention among
three-wheeler drivers?
Hypothesis:
The null hypothesis: There may not be significant improvement in pulmonary function test values of
three-wheeler drivers after using mask.
Research hypothesis: There may be significant improvement in pulmonary function test values of
three-wheeler drivers after using mask.
6.2) REVIEW OF LITERATURE :
Matthias Wjst, Peter Reitmeir, Sigrid Dold, Andrea Wulff, Thomas Nicolai, Erika von
Mutius .et al (1993) conducted a study on Road traffic and adverse effects on respiratory health in
children. Result of the study found that multiple regression analysis of peak expiratory flow showed
a significant decrease of 0x71% (95% confidence interval 1x08% to 0.33°/o) per increase of 25 000
cars daily passing through the school district on the main road. Maximum expiratory flow when
25% vital capacity had been expired was decreased by 0.68% (1.11% to 0.25%) and the result of
study concludes that high rates of road traffic diminish forced expiratory flow and increase
respiratory symptoms in children 6.
Zuskin E, Mustajbegovic J, Schachter EN (1994) examined the respiratory symptoms and lung
function in bus drivers and mechanics. They found that The Ventilatory capacity data demonstrated
lower values for all parameters, particularly FEF25, compared to control worker values as well as to
predicted normal values, for bus drivers and mechanics who were smokers and the result concludes
that long-term employment in the transport industry of bus drivers and mechanics, particularly in
combination with smoking, may be associated with the development of chronic respiratory
symptoms and lung function impairment.7
Rajkumar (1999) studied the effect of air pollution on respiratory system of auto rickshaw drivers
in Delhi. The study found that (19 percent) drivers showed normal Pulmonary Function Test (PFT).
(80 percent) showed mild moderate-severe obstruction, of which (48 percent) were non-smokers and
(52 percent) were smokers and the result concludes that auto rickshaw drivers have a high
respiratory morbidity due to exposure to pollution.8
Chattopadhyay BP, Alam J, Roychowdhury A (2003) compared the pulmonary function
abnormalities associated with exposure to automobile exhaust in a diesel bus garage and road. The
result of the study shows that there was restrictive impairment of 30.4% in conductors, 28.9% in
drivers, 27.9% in mechanics and 21.7% in administration people. Obstructive type of impairment
was found to be 2.9% in both drivers and conductors and concludes that the effect of pollution by
dust and fumes may be responsible for these pulmonary function impairments, restrictive
impairments being greater.9
K Sekine, M Shima, Y Nitta, M Adachi (2004) examined the Long term effects of exposure to
automobile exhaust on the pulmonary function of female adults in Tokyo, Japan. The study shows
that the annual mean change of FEV1 in group 1 was the largest (20.020 l/y), followed by that in
group 2 (20.015 l/y), and that in group 3 (20.009 l/y). Testing for trends showed a significant larger
decrease of FEV1 with the increase in the level of air pollution and the result of study concludes that
the subjects living in areas with high levels of air pollution showed higher prevalence rates of
respiratory symptoms and a larger decrease of FEV1 compared with those living in areas with low
levels of air pollution.10
Zafar Altaf Jafary, Ilyas Ahmed Faridi, Hamid Javaid Qureshi (2007) evaluated the effects of
airborne dust on lung function of the exposed subjects. The result of the study shows statistically
significant impairment of lung function parameter values of the exposed residents/workers of these
areas, proportionate to the extent of exposure to the roadside dust and the result concludes that The
inter-group comparison of lung function parameters in groups I, IIa and IIb showed association of
impairment with the extent of exposure to roadside dust levels.11
Anuj Chawla, A. K. Lavania (2008) conducted a study on air pollution and fuel vapour induced
changes in lung functions: are fuel handlers safe?. They found that FVC, FEV1 and PEF declined
significantly with increasing years of work in petrol stations in both smokers and non-smokers. The
FEF25-75 was found to be the most affected spirometric value with a significant reduction with
increasing years of work and concluded that Exposure to automobile exhaust and fuel vapour
impairs lung function in a time dependent manner.12
B.S. Jayalakshmi (2009) conducted a study to evaluate the pulmonary function tests in transport
workers from Chennai. The study found that FVC, FEV1, FEV1/FVC, PEFR measurements are
lower in the subjects with age 40 years and above and the study concludes that the mean values of
PFT in healthy non smoker workers of Transport Corporation, Chennai were lower than previously
reported data in healthy subjects of Tamil Nadu.13
Bijendra Kumar Binawara, Sushila Gahlot, Kamlesh Chandra Mathur, Ashok kakwar, Reshu
Gupta, Rajnee (2010) examined the pulmonary function test in three wheeler diesel taxi drivers in
Bikaner city. They found restrictive impairment in 87% of study group, of which 50% were smokers
and 37% were non-smokers, mixed pattern (both restrictive and early obstructive impairment) was
found in only 13% of study group, of which 7% were smokers and 5% non-smoker. So they
concluded that when all the five parameters (FVC, FEV1, FEV1/FVC, FEF 25–75% and PEFR)
were taken together they were indicative of mixed pattern (obstructive and restrictive) lung
impairments 2.
6.3) OBJECTIVES OF STUDY:
To check the pulmonary function test values in three-wheeler drivers.
To compare the efficacy of pulmonary function test values before and after introduction of mask in
three-wheeler drivers.
7.
MATERIALS AND METHODS:
7.1) STUDY DESIGN:
Experimental design.
7.2) SOURCE OF DATA:
50 three wheeler drivers with age range 20-50 years will be taken from three-wheeler stands
and three-wheeler driver’s union office of Mangalore.
7.2(I) DEFINITION OF THE STUDY SUBJECTS:
Three wheeler drivers will be taken in age range between 20-50 years.
7.2(II) INCLUSION AND EXCLUSION CRITERIA:
INCLUSION CRITERIA :
The subjects will be taken if they meet the following criteria.
 Males.
 Driving for at least one year.
 Age of 20-50years.
EXCLUSION CRIETERIA :
The subjects will be excluded from the study if they have the following conditions.

Females

Smokers

Subject with acute illness.

Subject with recent cardio-respiratory surgeries.

Subject with chronic cardio-respiratory illness.

Subject who cannot comprehend the spirometric instruction.
7.2 III STUDY SAMPLE DESIGN, METHOD, SIZE:
Sample design:
Cluster sampling.
Methods of Collection of data:
Samples with age of 20 – 50 years will be taken from various three-wheeler stands and
three-wheeler drivers’ union office of Mangalore.
Sample size:
50 subjects will be included in the study (50, three-wheeler drivers)
7.2 IV FOLLOW UP:
Pre and Post test will be conducted immediately after intervention.
7.2 V PARAMETERS USE FOR COMPARISON AND STATISTICAL TEST:
The collected data will be analysed by paired t-test.
7.2 VI DURATION OF STUDY:
Duration of the study will be 6 months.
7.2 VII METHODOLOGY:
50 three-wheeler drivers will be chosen from three-wheeler stand and three-wheeler union office of
Mangalore. They will be thoroughly screened by asking duration of driving and whether they have
any respiratory problem or acute illness.
The subject will be made to sit comfortably with arm supported. The subjects were explained the
procedure and informed consent was taken. Then Spirometric instruction were given and checked
for any exclusion criteria. The whole procedure was demonstrated by Physiotherapist in short sitting
position
PROCEDURE
The subjects in short sitting position with nose clip and mouth piece of spirometer placed in mouth.
Then subject is asked to take 2-4 normal breaths followed by active exhalation. Active exhalation is
followed immediately by forced inspiration and sudden maximum expiration and asked to continue
exhalation as long as possible. At last subject is asked to take a deep inspiration and told to relax by
taking the mouth piece out. Two to three readings are taken and the spirometer selects the best of
readings.
Ventilatory capacity measurements were performed by recording the maximum expiratory flowvolume (MEFV) curves on a spirometer (Spiro lab; Massimiliano Perillo; Maggiolino, ITALY). The
FVC, FEV1, and the maximum flow rate at 25% of FVC (FEF25) and the last 75% of the FVC
(FEF75) were recorded on the MEFV curves. Measurements were performed on three-wheelers
driver before providing protective mask for six months and again after the six months. The data
obtained by spirometer before and after intervention of mask will be analysed by paired t test.
7.3) Does the study require any investigations to be conducted on patients or other human or
animal if so please describe briefly?
Yes.
Pulmonary function test measurement using Spirometer.
7.4) Has ethical clearance been obtained from your institution in case of 7.3.
Yes
8.
List of References :
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environment 2001. Government of India; 2001. Report No.: 92-807-2014-7.
2. Bijendra Kumar Binawara, Sushila Gahlot, Kamlesh Chandra Mathur, Ashok kakwar, Reshu
Gupta, Rajnee. Pulmonary function tests in three wheeler diesel taxi drivers in Bikaner city.
Pak J Physiol 2010; 6(1):28-31.
3. N V Nanda Kumar, P Sreedhar Babu, A Nagarjuna. Health hazards of traffic police
occupationally exposed to automobile exhaust pollutants. National environmentalists
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4. Godhkhindi KD, Doshi VB. A cross sectional comparative study between 3 urban
communities (inclusive of slums) with different air pollution levels and a rural community
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6. Matthias Wjst, Peter Reitmeir, Sigrid Dold, Andrea Wulff, Thomas Nicolai, Edith Freifrau
von Loeffelholz-Colberg, Erika von Mutius. Road traffic and adverse effects on respiratory
health in children. BMJ. 1993; 307:596-600.
7. Zuskin E, Mustajbegovic J, Schachter EN. Respiratory symptoms and lung function in bus
drivers and mechanics. Am J Ind Med. 1994 Dec; 26(6):771-8
8. Rajkumar. Effect of air pollution on respiratory system of auto rickshaw drivers in Delhi.
Indian Journal of Occupational and Environmental Medicine. 1999 Oct-Dec.; 3(4):171-3.
9. Chattopadhyay BP, Alam J, Roychowdhury A. Pulmonary function abnormalities associated
with exposure to automobile exhaust in a diesel bus garage and roads. Lung. 2003; 181(5):
291-302.
10. K Sekine, M Shima, Y Nitta, M Adachi. Long term effects of exposure to automobile
exhaust on the pulmonary function of female adults in Tokyo, Japan. Occup Environ Med.
2004; 61:350–357.
11. Zafar Altaf Jafary, Ilyas Ahmed Faridi, Hamid Javaid Qureshi. Effects of airborne dust on
lung function of the exposed subjects. Pak J Physiol. 2007 Jun; 3(1):30-4.
12. Anuj Chawla, A.K. Lavania. Air pollution and fuel vapour induced changes in lung
functions: are fuel handlers safe?. Indian J Physiol Pharmacol. 2008; 52 (3):255–261.
13. B.S. Jayalakshmi. A study of pulmonary function tests in transport workers from Chennai.
Meenakshi Medical College & Research Institute. 2009 April 12.
14. Miller MR, Hankinson J, Brusasco V et al. Series “ATS/ERS Task Force: Standardisation of
Lung functions testing”. Eur Respir J 2005; 26:319–338.